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Background <p>The PAUSE-based reporting system provides a systematic approach for evaluating peritoneal carcinomatosis (PC) by assessing both the extent and size of tumor implants on peritoneal surfaces and involved organs, thereby facilitating preoperative treatment planning. This study aimed to compare magnetic resonance imaging (MRI) with multidetector computed tomography (MDCT) and to evaluate their agreement in the preoperative assessment of PC from pathologically proven primary gynecologic malignancies.</p> Methods <p>This cross-sectional analytical study included 30 female patients (mean age, 54.5 years; range, 37–72 years) with primary gynecological malignancies. Initial transabdominal or transvaginal ultrasound demonstrated peritoneal nodules, peritoneal masses, or suspected omental infiltration. All patients subsequently underwent MDCT and MRI. The time interval between the two imaging modalities did not exceed two weeks, ensuring minimal temporal variation in the disease status. Schematic assessment of the abdomen and pelvis was done following the PAUSE reporting checklist, including Primary malignancy and Peritoneal carcinomatosis index (PCI), Ascites and Abdominal wall infiltration, Unfavorable site infiltration, Small bowel and mesenteric involvement, and Extraperitoneal spread.</p> Results <p>Ovarian malignancies accounted for 25 of 30 patients (83.3%). MRI and MDCT demonstrated comparable performance in overall PCI assessment (<i>p</i> &gt; 0.05). Agreement between MRI and MDCT was substantial for ascites (κ = 0.80, <i>p</i> &lt; 0.001) and lymph node involvement (κ = 0.77, <i>p</i> = 0.03), moderate for abdominal wall involvement (κ = 0.57, <i>p</i> = 0.007), small-bowel involvement (κ = 0.57, <i>p</i> = 0.002), and extraperitoneal disease (κ = 0.53, <i>p</i> = 0.002), fair for unfavorable site involvement (κ = 0.27, <i>p</i> = 0.02). Diffusion-weighted imaging (DWI) provided incremental lesion detection by identifying 11 additional small peritoneal nodules and metastatic lymph nodes in two cases.</p> Conclusion <p>MRI and MDCT demonstrated substantial agreement across most evaluated parameters. MRI showed a trend toward improved detection of small peritoneal deposits and better assessment of small bowel involvement and extraperitoneal spread. Furthermore, DWI improved lesion conspicuity and lymph node detection. Overall, these findings support a complementary role for MRI in conjunction with MDCT.</p>

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Preoperative evaluation of peritoneal carcinomatosis in primary gynecologic malignancies: MRI versus MDCT using the PAUSE-based reporting system

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月1日

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  • Ghada Ali AboElfath Sheta,
  • Mariam Raafat,
  • Radwa Mahmoud Abdallah,
  • Eman Khaled Mahmoud,
  • Yasmin Essameldin Abdalla Khalifa

摘要

Background

The PAUSE-based reporting system provides a systematic approach for evaluating peritoneal carcinomatosis (PC) by assessing both the extent and size of tumor implants on peritoneal surfaces and involved organs, thereby facilitating preoperative treatment planning. This study aimed to compare magnetic resonance imaging (MRI) with multidetector computed tomography (MDCT) and to evaluate their agreement in the preoperative assessment of PC from pathologically proven primary gynecologic malignancies.

Methods

This cross-sectional analytical study included 30 female patients (mean age, 54.5 years; range, 37–72 years) with primary gynecological malignancies. Initial transabdominal or transvaginal ultrasound demonstrated peritoneal nodules, peritoneal masses, or suspected omental infiltration. All patients subsequently underwent MDCT and MRI. The time interval between the two imaging modalities did not exceed two weeks, ensuring minimal temporal variation in the disease status. Schematic assessment of the abdomen and pelvis was done following the PAUSE reporting checklist, including Primary malignancy and Peritoneal carcinomatosis index (PCI), Ascites and Abdominal wall infiltration, Unfavorable site infiltration, Small bowel and mesenteric involvement, and Extraperitoneal spread.

Results

Ovarian malignancies accounted for 25 of 30 patients (83.3%). MRI and MDCT demonstrated comparable performance in overall PCI assessment (p > 0.05). Agreement between MRI and MDCT was substantial for ascites (κ = 0.80, p < 0.001) and lymph node involvement (κ = 0.77, p = 0.03), moderate for abdominal wall involvement (κ = 0.57, p = 0.007), small-bowel involvement (κ = 0.57, p = 0.002), and extraperitoneal disease (κ = 0.53, p = 0.002), fair for unfavorable site involvement (κ = 0.27, p = 0.02). Diffusion-weighted imaging (DWI) provided incremental lesion detection by identifying 11 additional small peritoneal nodules and metastatic lymph nodes in two cases.

Conclusion

MRI and MDCT demonstrated substantial agreement across most evaluated parameters. MRI showed a trend toward improved detection of small peritoneal deposits and better assessment of small bowel involvement and extraperitoneal spread. Furthermore, DWI improved lesion conspicuity and lymph node detection. Overall, these findings support a complementary role for MRI in conjunction with MDCT.